Creating a vision for health

With both a State and Federal election on the horizon, it’s the perfect opportunity to consider health as an ecosystem – adequately resourcing and planning the systems to work in conjunction with each other.

Healthcare is complex.

And when faced with a complicated problem or issue, it is tempting to just work on a little bit here and there, focusing on a waiting list or busy emergency department without regard to the underlying causes.

The problem with this sort of Band-Aid approach is that without regard to the wider system, there are often unintended impacts and greater inefficiency. It’s the approach of trying to fix traffic congestion only by building more roads.

For too long successive Governments at the State and Federal level have not taken a holistic view of health. For every new project or service, we need to be asking: ‘How does this fit with the rest of the system?’

We need more capacity to treat people when they get sick. But healthcare is more than just hospitals. If we don’t start fixing our healthcare system, we will never have enough hospitals. It’s tempting to just ‘build another lane on the M4’ – but that approach doesn’t work with health.

In this issue, we break down our vision for a healthier NSW. The Election Priorities focuses on three areas of priority: Healthy Hospitals, Healthy Systems and Healthy Communities.

The overarching principle is that both levels of government need to work together and look at the health system as a whole. We’ve reached a critical period in healthcare where population growth intersects with an ageing population that is increasingly affected by chronic disease. Our hospitals are struggling to cope with patient demand and without greater resourcing they won’t be able to meet the health needs of NSW residents.

And while we need continued funding for hospitals and a plan to address workforce shortages, the key to curbing the hospital crisis will be supporting a strong primary care system. It is the backbone of the health system and central to keeping people out of hospitals.

This is why NSW is joining Federal AMA in calling ‘Time for 10’. It’s time to increase funding for primary care to 10% of the total health budge. And this must be in the form of new money.

While spending on other areas of health have increased, primary care services are still a relatively small proportion of total government health expenditure.

A substantial body ofs international research indicates primary care is the most cost-effective way to provide healthcare. Research from Bettering the Evaluation and Care of Health (BEACH) found there were 35 million more GP services in 2013-14 than 10 years earlier – a 36% increase. There were 17 million more attendances by patients aged 65 years and over, which represented a 67% increase.

In 2015-16, GPs managed 154 problems per 100 encounters, which was a significant increase from a decade earlier (149 per 100). The BEACH data suggests in 2015-16 there were 21 million more chronic problem management consultations than 10 years previously.

What this data reveals is that GPs are looking after more patients with increasingly complex needs.

The average cost of seeing a GP is $47 compared to an ED visit, which ranges from $396 to $599, according to BEACH figures.

Given the value primary care provides, as well as the increase in conditions being managed by general practitioners, and the time spent with individual patients, it is vital we dedicate more of the budget to primary care. But this can’t be at the expense of hospitals. We need to consider both systems together – building our hospitals, our primary care and our communities in conjunction with each other.

By taking a holistic view of health, we will build a system that is better integrated, and better able to manage the increasingly complex health needs of an ageing society.